German Society of Oto-Rhino-Laryngology, Head and Neck Surgery.
81st Annual Meeting of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery.
Wiesbaden,
12.-16.05.2010.
DÃ¼sseldorf: German Medical Science GMS Publishing House; 2010. Doc10hno020

Gliederung

Introduction: Developments in laparoscopic surgery has lead to an increase of these approaches in different disciplines. Additionally natural orifice approaches are under exploration with the aim to further reduce surgical access trauma. We have developed a trans-oral endoscopic access for thyroid resection and studied now the application of this approach in mediastinal surgery.

Methods: Anatomical study in 5 fresh frozen cadavers: through a midline sublingual incision an optical scissor is placed through a trocar in the pretracheal region. Under vision a working space is created. 2 additional working trocars are brought in place by bi-vestibular oral incisions. The trachea dissected. A bi-paratracheal compartment resection of the lymph nodes (station II and IV) and the region of the tracheal bifurcaton (station VII) were performed. Specimens were removed through the midline channel. A dissection followed to estimate collateral damage.

Results: In all cases the target region could be reached endoscopically, no conversion was necessary. Landmarks (brachiocervical trunc, azygos vein, pulmonary artery) could be visualized and kept intact. A working space in the mediastinum could by established. Harvesting of the specimen through the midline channel was possible. Dissections showed no collateral damages. Furthermore all paratracheal lymph nodes as well as the fatty tissue surrounding these could be resected.

Discussion: We could show, that the mediastinum can be reached by an endoscopic trans-oral approach based on natural orifice surgery. A complete compartment resection of the paratracheal lymph node-stations was possible in a well designed and clearly visible working space.